– Surgery is required for Grade III cases in order to allow nipple to protract

– Lactiferous ducts severely retracted (not able to breastfeed)

– Severe degree of fibrosis

– Soft tissue is deficient

– Rarely able to pull out nipple manually and is done with extreme effort

– Increase chance of infections or rashes occurring due to inadequate nipple hygiene

What causes inverted nipple?

Nipple inversion could occur due to being born with it, genetics, pregnancy, physiological changes of the breast (i.e. drooping), trauma, cancer, infections and other diseases.

What to expect before surgery?

Women who are considering to have surgery done to correct the structure of their nipple must be aware that they may no longer be able to breastfeed. Dr. Colin Hong will further discuss with patients on the nature of the procedure, potential risks and side effects, expected results and recovery process in greater detail during appointments before surgery.

What occurs during surgery?

In general, a small incision is done at the lower portion of the nipple and a sophisticated pattern of stitches (purse-string suture) is conducted to support the nipple, thus correcting the nipple’s shape. The patient is under anesthetics during the procedure. Markings are done before surgery begins to highlight the target areas where the incisions will be made.

To meet the demands of the different types of inverted nipples, grade (I,II,III) and pigmentation of the skin of the patient is considered when choosing which technique is most suitable to use. Dr. Colin Hong will assure to make the right decision to produce the most optimal and desirable results for the patient.

For mild conditions, the milk ducts are stretched (non-incisional) and for grade II, the lactiferous ducts are preserved but the fibrosis are released until the desire projection is obtained

For more severe cases, the milk ducts are divided with the release of fibrosis and the purse-string suture is used as well.

There are many other alternative techniques used for fixing the inverted nipples. Some of the recent different types of technique used are:

Antenna Flap Technique

This technique caters to the grade III case. The dermadipose flaps (the skin located under the nipple) is stripped, this process refers to de-epithelialization area of the mastropexy.

The fat tissue and dermis beneath the first layer of the skin is exposed and then removed. An implant is placed inside the created pocket of the submuscular space and then stapled. After healing, the second part of the surgery can begin. The staples are removed and another pocket was made for the antenna flaps underneath the nipple. Tissue beneath the nipple and lactiferous is dissected and the fibrosis is released. Then the antenna flaps are placed inside the created pocket.

Lastly, a purse-string fashion suture was used to close the incision. This technique is only available for patients who are candidates for mastroplexy.

Twisting and locking technique

This technique caters to all grade cases (except for patients with light coloured areloa or an arelora with a small diameter).A. A diamond-shaped pattern are carefully measured and marked on the areolar, which later on turn into diamond-shaped flaps after de-epithelialization (B)C. A tunnel is created underneath the nipple by fibrotic bands.D. The elevated dermal flaps go through the tunnel then is pulled outE. Dermal flaps are stitched to the opposite side of the de-epithelialization area.Potential risk: Discolouration of the arelora

Triangular areolar dermal flaps technique

Ideal for grade II cases.A&B: Two triangle patterns are marked, used to make the incision and create the areolar dermal flaps after de-epithelialization of the triangle area. The triangles are 1mm shorter than the diameter of the nipple.C: The nipple is pulled out to allow the removal of the fibrous tissue and afterward, both the areolar dermal flaps are pulled with a suture through the slit where they cross.D: Further stitching is done to attach the structure with the lower dermis of the nipple. Lastly, the area is closed up and the sutures are removed.Potential Risk: Minimal scars

Internal 5-point star suture technique

This technique is ideal for grade III case. This technique consists of using autologous or heterologous material. The effect of using this material provides the nipple of the appearance of having more volume and projection. The nipple is pulled out, fibrosis is realized, polyglactin is introduced as a filling material and a internal star suture surrounds the nipple.

Nipple Retractors

A suture is used to elevate the nipple causing it to project outwards. The suture is anchored to the areola skin with empty needles. The nipple is then surrounded and coated with a material consisting of cotton gauze and paper tape. The material is taken off after 6 months. It is clinically significant in treating mild cases of inverted nipples.

What occurs after surgery?

This is an outpatient procedure meaning that the patient is not required to stay overnight at the hospital and may leave a few hours after the surgery.

Patient should expect to feel pain, swelling, soreness, and sensitivity around the area of their nipple. Such discomforts should subsidize in a couple of days. Overall, recovering time for the procedure could last up to a week or more, dependent on the individual.

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